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Objective@#To observe the clinical and electrophysiological characteristics of botulinum toxin A poisoning induced by local cosmetic injection, and to explore the possible pathogenesis.@*Methods@#Clinical data of 20 patients with botulinum toxin type A local cosmetic injection poisoning admitted to our hospital from January 2016 to December 2018 were collected and electrophysiological tests were carried out.@*Results@#The clinical manifestations of 20 patients were mainly 15/20 (75.0%) with limb weakness, and the proximal end was heavier than the distal 20/20 (100%), and the upper limb was heavier than the lower limb 26/20 (80%), followed by dysphagia 12/20 (60%), dysarthria 5/20 (25%), cervical muscle weakness 5/20 (25%), extraocular muscle paralysis 4/20 (20%), masseter muscle weakness 3/20 (15%) and respiratory muscle weakness 2/20 (5.0%) with respiratory failure 1/20 (5.0%). The results of neurophysiological examination showed the highest rate of SFEMG (90.0%), followed by RNS (80.0%), EMG (65.0%) and NCV (40.0%), suggesting that neuromuscular junction dysfunction was the main presentation. Patients who actively gave botulinum antitoxin injection therapy and symptomatic support treatment had good prognosis.@*Conclusions@#Local cosmetic injection of botulinum toxin type A may lead to poisoning. The symptoms of poisoning are mainly caused by limb weakness. Neuroelectrophysiological examination can assist in the diagnosis of botulinum toxin poisoning.
RESUMO
Objective To investigate the pathological and electro-physiological process of terminal sprouting after muscle injection of Botulinum toxin type A(BTXA) in rats. Methods Sprague-Dawley rats were randomly divided into a BTXA group and a control group. Five unit of BTXA was injected into the right gastrocnemius of the rats in BTXA group, instead of 0.9% saline in the control group. The morphologic axon analysis and SFEMG (mean consecutive difference and fiber density) were measured at 1,4,8,12 week after injection. Results The mean consecutive difference was prolonged in 1-4 week, and got better at 8 week, recovered at 12 week. It was revealed of the recovery of neuromuscular junction at 12 week after BTXA injection. The results of fiber density and morphologic axon analysis demonstrated terminal sprouting after injection of BTXA. Conclusion Motor nerve terminal sprouting could appear after BTXA injection and the function of neuromuscular junction could become recovered at 12 week.